Verbal feedback enhances motor learning during post-stroke gait retraining

ABSTRACT

Background

Fast treadmill walking combined with functional electrical stimulation to ankle muscles (FastFES) is a well-studied gait intervention that improves post-stroke walking function. Although individualized verbal feedback is commonly incorporated during clinical gait training, and a variable practice structure is posited to enhance learning, the influence of these two factors on motor learning during locomotor interventions such as FastFES is poorly understood.

Objectives

To determine if the addition of individualized verbal feedback or variable practice to a FastFES training session enhances motor learning of targeted gait patterns.

Methods

Nine individuals with post-stroke hemiparesis completed a crossover study comprising exposure to 3 dose-matched types of gait training: (1) FastFES (FF), comprising five 6-minute bouts of training with intermittent FES, (2) FF with addition of individualized verbal instructions and faded feedback delivered by a physical therapist (FF+PT), (3) FF with variable gait speed and FES timing (FF+Var). Gait biomechanics data were collected before (Pre), immediately after (Post), and 24-h following (Retention) each training type. Within-session and retention change scores of 3 targeted gait variables were calculated to assess locomotor learning.

Results

FF+PT resulted in larger improvements within-session and at retention in trailing limb angle, and a trend for larger improvements in paretic pushoff compared to FF. FF+Var failed to show greater learning of biomechanical variables compared to FF.

Conclusions

Addition of individualized verbal feedback (FF+PT) to a single session of gait training may enhance within- and across-session learning of targeted gait variables in people post-stroke, and merits more investigation.

KEYWORDS:

• Verbal instructions
• walking
• rehabilitation
• variable practice
• cerebrovascular accident
• gait propulsion

Additional information

Funding

This work was supported by the NIH NICHD under grant numbers R01 HD095975 and K01 HD079584; and the American Heart Association (AHA) under Scientist Development Grant number 13SDG13320000.